Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction
BackgroundMicrovascular injury (MVI) after primary percutaneous coronary intervention for ST‐elevation myocardial infarction (STEMI) is a major determinant of adverse clinical outcome. Experimental data indicate an impact of hypercholesterolemia on MVI; however, there is a lack of clinical studies c...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2017-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.117.006957 |
| _version_ | 1818312320223281152 |
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| author | Martin Reindl Sebastian Johannes Reinstadler Hans‐Josef Feistritzer Markus Theurl Daniel Basic Christopher Eigler Magdalena Holzknecht Johannes Mair Agnes Mayr Gert Klug Bernhard Metzler |
| author_facet | Martin Reindl Sebastian Johannes Reinstadler Hans‐Josef Feistritzer Markus Theurl Daniel Basic Christopher Eigler Magdalena Holzknecht Johannes Mair Agnes Mayr Gert Klug Bernhard Metzler |
| author_sort | Martin Reindl |
| collection | DOAJ |
| description | BackgroundMicrovascular injury (MVI) after primary percutaneous coronary intervention for ST‐elevation myocardial infarction (STEMI) is a major determinant of adverse clinical outcome. Experimental data indicate an impact of hypercholesterolemia on MVI; however, there is a lack of clinical studies confirming this relation. We aimed to investigate the association of cholesterol concentrations on admission with MVI visualized by cardiac magnetic resonance imaging and clinical outcome in STEMI patients treated by primary percutaneous coronary intervention. Methods and ResultsIn this prospective, observational study, we included 235 consecutive revascularized STEMI patients. Cholesterol (total cholesterol, low‐density lipoprotein [LDL], and high‐density lipoprotein cholesterol) and triglyceride concentrations were determined at presentation. Cardiac magnetic resonance scans were performed 2 (2–4) days after infarction to assess infarct characteristics, including MVI. Clinical end point was the occurrence of major adverse cardiac events (MACE) comprising all‐cause mortality, nonfatal reinfarction, and new congestive heart failure. Patients with MVI (n=129; 55%) showed higher levels of total cholesterol (204 [172–226] versus 185 [168–212] mg/dL; P=0.01) and LDL cholesterol (142 [113–166] versus 118 [103–149] mg/dL; P=0.001), whereas high‐density lipoprotein cholesterol and triglycerides did not differ significantly. In multivariable analysis, including all significant clinical and cardiac magnetic resonance determinants of MVI, LDL concentration emerged as an independent predictor of MVI (odds ratio, 1.02 [95% confidence interval, 1.01–1.02]; P=0.002). Furthermore, increased LDL cholesterol (>150 mg/dL) significantly predicted the occurrence of major adverse cardiac events (hazard ratio, 3.09 [95% confidence interval, 1.22–7.87]; P=0.01). ConclusionsIn STEMI patients undergoing primary percutaneous coronary intervention, baseline LDL cholesterol concentrations were independently associated with MVI, revealing a clinically relevant link between LDL metabolism and MVI in acute STEMI. |
| first_indexed | 2024-12-13T08:15:58Z |
| format | Article |
| id | doaj.art-1e51a0925a99457c8ef27cc036f056e5 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-13T08:15:58Z |
| publishDate | 2017-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-1e51a0925a99457c8ef27cc036f056e52022-12-21T23:54:07ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802017-10-0161010.1161/JAHA.117.006957Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial InfarctionMartin Reindl0Sebastian Johannes Reinstadler1Hans‐Josef Feistritzer2Markus Theurl3Daniel Basic4Christopher Eigler5Magdalena Holzknecht6Johannes Mair7Agnes Mayr8Gert Klug9Bernhard Metzler10University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Radiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaUniversity Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, AustriaBackgroundMicrovascular injury (MVI) after primary percutaneous coronary intervention for ST‐elevation myocardial infarction (STEMI) is a major determinant of adverse clinical outcome. Experimental data indicate an impact of hypercholesterolemia on MVI; however, there is a lack of clinical studies confirming this relation. We aimed to investigate the association of cholesterol concentrations on admission with MVI visualized by cardiac magnetic resonance imaging and clinical outcome in STEMI patients treated by primary percutaneous coronary intervention. Methods and ResultsIn this prospective, observational study, we included 235 consecutive revascularized STEMI patients. Cholesterol (total cholesterol, low‐density lipoprotein [LDL], and high‐density lipoprotein cholesterol) and triglyceride concentrations were determined at presentation. Cardiac magnetic resonance scans were performed 2 (2–4) days after infarction to assess infarct characteristics, including MVI. Clinical end point was the occurrence of major adverse cardiac events (MACE) comprising all‐cause mortality, nonfatal reinfarction, and new congestive heart failure. Patients with MVI (n=129; 55%) showed higher levels of total cholesterol (204 [172–226] versus 185 [168–212] mg/dL; P=0.01) and LDL cholesterol (142 [113–166] versus 118 [103–149] mg/dL; P=0.001), whereas high‐density lipoprotein cholesterol and triglycerides did not differ significantly. In multivariable analysis, including all significant clinical and cardiac magnetic resonance determinants of MVI, LDL concentration emerged as an independent predictor of MVI (odds ratio, 1.02 [95% confidence interval, 1.01–1.02]; P=0.002). Furthermore, increased LDL cholesterol (>150 mg/dL) significantly predicted the occurrence of major adverse cardiac events (hazard ratio, 3.09 [95% confidence interval, 1.22–7.87]; P=0.01). ConclusionsIn STEMI patients undergoing primary percutaneous coronary intervention, baseline LDL cholesterol concentrations were independently associated with MVI, revealing a clinically relevant link between LDL metabolism and MVI in acute STEMI.https://www.ahajournals.org/doi/10.1161/JAHA.117.006957low‐density lipoprotein cholesterolmagnetic resonance imagingmicrovascular dysfunctionrisk stratificationST‐segment elevation myocardial infarction |
| spellingShingle | Martin Reindl Sebastian Johannes Reinstadler Hans‐Josef Feistritzer Markus Theurl Daniel Basic Christopher Eigler Magdalena Holzknecht Johannes Mair Agnes Mayr Gert Klug Bernhard Metzler Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease low‐density lipoprotein cholesterol magnetic resonance imaging microvascular dysfunction risk stratification ST‐segment elevation myocardial infarction |
| title | Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction |
| title_full | Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction |
| title_fullStr | Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction |
| title_full_unstemmed | Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction |
| title_short | Relation of Low‐Density Lipoprotein Cholesterol With Microvascular Injury and Clinical Outcome in Revascularized ST‐Elevation Myocardial Infarction |
| title_sort | relation of low density lipoprotein cholesterol with microvascular injury and clinical outcome in revascularized st elevation myocardial infarction |
| topic | low‐density lipoprotein cholesterol magnetic resonance imaging microvascular dysfunction risk stratification ST‐segment elevation myocardial infarction |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.117.006957 |
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